Evaluation of Knee Joint after Open Reduction and Internal Fixation Surgery of Posterior Cruciate Ligament in Patients with Avulsion Fracture

BACKGROUND:

The posterior cruciate ligament is one of the important tissues and structures sustaining the knee joint, and its rupture or detachment may lead to joint instability or destruction.

AIM:

The present study aimed at investigating the Open Reduction and Internal Fixation surgery of posterior cruciate ligament and comparing it to the normal knee of the same side.

METHODS:

In this study, 25 patients with avulsion fracture at the PCL joint were treated with open surgery and screw fixation. The patients were followed up by Lysholm knee score for at least 12 months after surgery.

RESULTS:

All patients were male with an average age of 25 years over the years 2010-2018. The common mechanism of injury in these patients was motorcycle-car accident. In the study with Lysholm knee score, 21 patients (80%) obtained the good score of 60-90 while 20% of patients were placed in the fair group (30-59). The average score was 86.

CONCLUSION:

The obtained score of knee function questionnaire in this study had no significant difference from other similar studies, and most patients achieved a good and acceptable score after the surgery. There was no knee instability and functional impairment in the patients compared to the normal knee. Considering the clinical results after the fixation of the PCL avulsion fracture causing a significant improvement in patients, the surgery could be considered as an acceptable and effective method for treating such impairment and fracture.

Evaluation of the Additive Effect of Domperidone on Patients with Refractory Gastroesophageal Reflux Disease; A Randomized Double Blind Clinical Trial

BACKGROUND

Gastroesophageal reflux disease (GERD) is a common problem with annoying symptoms. It is associated with negative impact on quality of life. Prokinetic agents may be used in combination with acid suppression agents as an adjunctive in patients with GERD refractory to proton pump inhibitors (PPI) therapy, rather than as sole treatment. This study aimed to evaluate the efficacy of combination of PPI with domperidone (a prokinetic agent) compared with PPI alone in the treatment of patients with refractory GERD.

METHODS

This study was a double blind clinical trial on 29 patients with GERD refractory to PPI during the period of one month. By randomization, the patients were divided into two groups. Group A was treated by pantoprazole 40 mg twice daily and domperidone three times a day for a month, while group B was treated by pantoprazole 40 mg twice daily and placebo three times a day. In this study endoscopy was performed to evaluate the prevalence of erosive esophagitis, non-erosive reflux, and hiatal hernia. Manometry was conducted to study the prevalence of dysmotility. GERD symptom questionnaires including the Gastrointestinal Symptom Rating Scale (GSRS), Carlson Dennett, and the Medical Outcomes Study Short Form-36 health survey (SF36) were used before and after treatment for screening GERD and assessing treatment response.

RESULTS

There were 17 (58.62%) women and 12 (41.37%) men. The prevalence of erosive esophagitis and non-erosive reflux, was 10.34% and 89.66%, respectively. There was a significant difference comparing reflux symptoms before and after treatment between the two groups according to reflux and Carlson Dennett questionnaires. At the end of the study, symptoms of reflux significantly improved by treatment. Although, the quality of life questionnaire scores improved by treatment, there was no statistically significant difference in response to treatment between the two groups.

CONCLUSION

In this research, we showed that adding domperidone to PPI could not make any improvement in patients with refractory reflux regarding the quality of life and improving the symptoms.

Pilonidal Sinus Operations Performed Under Local Anesthesia versus the General Anesthesia: Clinical Trial Study

Backgrounds:

Various methods were defined to prepare patients for the pilonidal sinus surgery including local, spinal, and general anesthesia. But there is no powerful evidence to differ these procedures. Therefore, in the current study, we compared local and general anesthesia in the pilonidal sinus surgery.

Methods and Material:

In this clinical trial (IRCT201312031786N5) study 60 patients with the pilonidal sinus disease divided to two groups of local anesthesia versus general anesthesia. For local anesthesia we used 6ml of 2% lidocaine with an epinephrine (1:200,000), 6 ml of 0.5% bupivacaine, 1ml fentanyl (50 μg/ml), 1ml clonidine (75 μg/ml) and for general anesthesia fentanyl 1.5 μg.kg^-1, thiopental 3-5 mg.kg^-1, followed by the trachea intubation facilitated by atracurim 0.5 mg.kg-1 with maintenance of isoflurane 1-3% in nitrous oxygen 70% and oxygen 30%. The student t-test and Chi-square test were applied to evaluate the differences.

Results:

There were 30 patients with the mean age of 27.43±8.42 years in local anesthesia group and 30 cases with the mean age of 27.5±8.44 years underwent general anesthesia. The recovery time was significantly lower in the local anesthesia group (P=0.000). The oxygen saturation of the general anesthesia group was significantly higher at 1 and 20 minutes after the operation. The average of pain score was significantly higher in general anesthesia group at 3h and 6h after surgery (P<0.001). There were no significant differences in post-operative complications and hospital length of stay.

Conclusion:

This investigation revealed that local anesthesia has decreased pain during 48 hours after the surgery, shorter recovery time, and the less consumption of painkillers. So, we concluded that we can consider local anesthesia as a good alternative for the general anesthesia in the pilonidal sinus surgery.

Comparison of totally tubeless percutaneous nephrolithotomy and standard percutaneous nephrolithotomy for kidney stones: a randomized, clinical trial

This study aimed to compare the totally tubeless percutaneous nephrolithotomy and standard percutaneous nephrolithotomy techniques regarding their rates of success and complications in patients with kidney stones. Patients were randomly assigned to two groups. Forty-four patients (24 men; mean age: 50.40±2.02 years) received totally tubeless percutaneous nephrolithotomy (PCNL; no nephrostomy catheter or ureteral catheter after PCNL) and 40 patients (18 men; mean age: 49.95±13.38 years) underwent standard PCNL (a nephrostomy catheter and ureteral catheter were used after PCNL). All surgeries were performed by one surgeon. Postoperative changes in hemoglobin, the blood transfusion rate, changes in creatinine levels, operation time, analgesic need, hospitalization time, and complication rate were compared between the groups. No significant differences were observed in age, gender, stone size, and surgery side between the groups (P<0.05). The operation time was significantly lower in the totally tubeless PCNL group than in the standard PCNL group (P=0.005). Pethidine requirements were significantly higher in the standard PCNL group than the totally tubeless PCNL group (P=0.007). Hospitalization time was significantly higher in the standard PCNL group than in the totally tubeless PCNL group (P<0.0001). The complication rate was 15% in the standard PCNL group and 9.1% in the totally tubeless PCNL group (P=0.73). The totally tubeless PCNL technique is safe and effective, even for patients with staghorn stones. This technique is associated with decreased pain, analgesic needs, and operative and hospitalization time. We believe that a normal peristaltic ureter is the best drainage tube.

Comparison of GnRh Agonist Microdose Flare Up and GnRh Antagonist/Letrozole in Treatment of Poor Responder Patients in Intra Cytoplaspic Sperm Injection: Randomized Clinical Trial

Backgrounds:

the prevalence of infertility is up to 10 to 15 % which 9 to 24 % of them are Poor Ovarian Responders (POR). This study was designed to compare two methods of GnRH Agonist Microdose Flareup (MF) and GnRH Antagonist/Letrozole (AL) in treatment of these patients.

Methods and Materials:

this randomized clinical trial study consisted of 123 patients. In the first step of treatment in both methods FSH, LH, estradiol, anderostandion, testestron in third day of menstruation period and the thickness of endometrium by Transvaginal sonography were evaluated. At the time of HCG injection the thickness of endometrium and follicles which were more than 14mm ware established and hormones were evaluated. Two weeks later serum βhCG and after 6 to 8 weeks Transvaginal sonography were applied to prove the pregnancy.

Results:

there were 61 patients with mean age of 38.7±4.58 in MF group and 62 patients with mean age of 38.5±4.6 in AL group (P=0.80). At the time of hCG injection there were significant increase in the level of LH, estradiol, thickness of endometrium and follicles more than 14mm in MF patients (P<0.0001). The mean time of ovary stimulation in MF group was 10.72±1.5 and in AL was 8.45±1.2 (P<0.0001). The mean level of gonadotropin which were used was 80.6±20.1 in MF patients and 64.7±16.4 in AL group (P<0.0001). 18 % of MF group and 38.7% in AL group had no normal cycle of ovulation (OR: 2.87, 95% CI: 1.25-6.57, P=0.011). The mean numbers of oocyte and normal fetus in MF was 5.83±3.5 and 3.7±2.5 and in AL was 3±1.69 and 1.4±1.33 (P<0.0001). The number of chemical pregnancy in MF group was 10 (16.4%) and in AL was 3 (4.8%) (OR 3.85, 95% CI: 1.06-14.77, P=0.037). Clinical pregnancy in 10 patients (16.4%) of MF group and 3 (4.8%)in AL was reported. OR 3.85, 95% CI: 1.06-14.77, P=0.037).

Conclusion:

this study showed that MF method of pregnancy leads to more positive results in pregnancy based on chemical and clinical evaluation in comparison with AL and is advised for poor responder patients.

Comparison of Two Levels of Pressure Support Ventilation on Success of Extubation in Preterm Neonates: A Randomized Clinical Trial

Background:

Pressure Support Ventilation (PSV) is one of the modes of mechanical ventilation that can be used alone as a weaning strategy in neonates. However, studies on the appropriate pressure level for this mode in neonates are limited.

Objectives:

Because the use of adequate pressure support in this mode, keeping the appropriate neonate’s tidal volume, and preventing the respiratory complications, this study was aimed to compare extubation failure in the two levels of pressure support ventilation of 10 and 14 cmH2O when removing the neonates from the ventilator.

Materials & Methods:

In this randomized clinical trial 50 premature infants of 27-37 weeks with respiratory distress syndrome (RDS) were under mechanical ventilation for at least 48 hours, were randomly assigned to two groups. One group was extubated in PSV mode with pressure of 14 cmH₂O and the other with 10 cmH₂O. Extubation failure rate and complications such as pneumothorax, death and respiratory parameters were compared in the two groups.

Results:

Twenty five neonates in each group were assessed. Weaning time, extubation failure rate, and mean airway pressure was lesser in PSV of 10 cmH20 group than Level of 14 cmH2O and those differences were statistically significant (P<0.05). Difference between work of breathing, ventilation time, pneumothorax and mortality rate between two groups were not statistically significant (P>0.05).

Conclusion:

The results of our study show that extubation of the neonates using 10 CmH₂O in PSV mode increases the success rate of extubation. Although when Volume- assured PSV can be used, it is more logical to use it for guaranteeing tidal volume, but using the appropriate level of pressure support when the PSV mode is used alone is inevitable and further studies are necessary to demonstrate the level of pressure in this mode.

The incidence of nasal septal deviation and its relation with chronic rhinosinusitis in patients undergoing functional endoscopic sinus surgery

OBJECTIVE

To investigate the correlation of nasal septal deviations and chronic rhinosinusitis.

METHODS

The study was conducted at Department of Otolaryngology, Head and Neck Surgery, Boali Hospital, Sari, Iran from January 2012 to September 2014 and comprised subjects aged from 5 to 68 years who had undergone elective functional endoscopic sinus surgery for chronic rhinosinusitis. SPSS 17 was used for statistical analysis.

RESULTS

Of the 60 subjects in the study, 41(68.3%) were males and 19(31.7%) females with overall median age of 27. Nasal septal deviation was found in 49(81.7%) subjects; 11(18.3%) had it in both right and left sides, 16(26.7%) in right alone and 22(36.7%) in the left side. The commonest type of septal deviations in the left side were posteroinferior 10(16.66%) and anteroinferior 7(11.7%). In the right side, the corresponding numbers were 9(15%) and 7(11.7%).

CONCLUSIONS

Nasal septal deviations are of particular interest in majority of patients with chronic rhinosinusitis.

The Review on Properties of Aloe Vera in Healing of Cutaneous Wounds

Treatment of wounds is very important and was subject of different investigations. In this regard, natural substance plays crucial role as complementary medicine. Various studies reported that aloe vera has useful effects on wounds especially cutaneous wounds healing. Therefore in the current review, we examined the effect of aloe vera on cutaneous wound healing and concluded that although aloe vera improves the wound healing as well as other procedures both clinically and experimentally, more studies are still needed to approve the outcomes.

A Survey of Severity and Distribution of Musculoskeletal Pain in Multiple Sclerosis Patients; a Cross-Sectional Study

BACKGROUND

Pain, a common phenomenon in multiple sclerosis (MS) patients, is associated with many symptoms and problems.

AIM

To investigation severity and distribution of musculoskeletal pain in MS patients.

METHODS

In this cross-sectional study, 115 members of the Mazandaran MS Association with confirmed MS were randomly selected to participate in the study. The patients were asked to fill out Numerical Rating Score and Nodric questionnaires, respectively. The data was analyzed by SPSS ver. 16 software.

RESULTS

The mean age of the participants was 30.43±5.86 years and 88 cases (76.5%) were female. The mean disease duration was 26.34±24.32 months and 87.8% of the cases were experiencing pain at the time of study. The mean pain severity was 3.75±2.25 and worst pain experienced was 5.73±2.12. The most common pain sites were: the knees (55.7%), wrist (43.5%), and neck (41.7%). Women experience higher prevalence of shoulder, upper back, and ankle pain (P<0.05). In 62 cases (53.91%) MS interfered with daily functioning at least for a time. The prevalence of upper back and neck pain was higher in cases with a shorter disease duration (P<0.05).

CONCLUSIONS

Pain was very common in patients with MS and not relevant to sex or age. In the majority of the cases more than 1 limb was involved and the prevalence of pain in the lower limbs was higher, especially in the knees. In females, the prevalence of pain in the shoulders, upper back, and ankle was higher compared to males. Also, neck and upper-back pain were found in the early stages of the disease.

Characterisation of up-regulated immunoglobulins in patients with chronic rhinosinusitis

OBJECTIVE

To evaluate the role of immunoglobulins in patients of chronic rhinosinusitis.

METHODS

Patients were recruited from the Ear, Nose, Throat, Head And Neck Surgery section of Mazandaran University of Medical Sciences, Sari, Iran, from December 2011 to August 2012. Immunoglobulin G, IgG1, IgG2, IgG3, IgG4 were evaluated. Salivary IgA was assessed by direct immunoenzymatic determination. The quantifications of serum IgG, IgG1, IgG2, IgG3, IgG4 and salivary IgA was performed through nephelometric procedure. Serum IgE was measured by enzyme-linked immunoabsorbent assay. SPSS 15 was used for statistical analysis.

RESULTS

Of the 50 patients, 22 (44%) were males and 28 (56%) were females. The overall age ranged from 1 to 67 years with a mean of 28.06 +/- 15.49. There was significant changes in levels of IgG, IgG1, salivary IgA and IgE (p = 0.001). Significant difference was noted for IgG2 (p = 0.03) and in IgG4 (p = 0.01). There was no significant alteration in IgG3 level (p = 0.3).

CONCLUSION

There was high prevalence of humoral immune alterations both in local and systemic response to chronic inflammation in the patients, which suggests that assessment of immunoglobulin before clinical evaluation and management could be important.

Vitamin E and its clinical challenges in cosmetic and reconstructive medicine with focus on scars; a review

Hypertrophic scars are abnormal scars that develop after wound-healing, especially in some ethnic backgrounds. The after-effects of these scars result in depression, posttraumatic stress syndrome, anxiety, impaired self-esteem and quality of life. Treatment of these scars still is a subject of different studies and is a challenging issue in reconstructive medicine. We reviewed the current published articles about the effects of vitamin E on scar formation and its clinical effectiveness. The application of vitamin E is popular interest, but it still needs more clinical studies to establish its perceived outcomes.

Clinical management and outcomes of papillary, follicular and medullary thyroid cancer surgery

The clinical characteristics, pathological subtypes and patients' survival in 40 patients with thyroid carcinoma between March 2007 and March 2012 were evaluated. This study included 33 (82.5 %) females and seven (17.5%) males (female to male ratio of 4.7:1). The median age of patients was 47.5 (range; 24-64). Papillary carcinoma was the commonest pathological subtype (23 patients, 57.5%), followed by follicular carcinoma (14 patients, 35%) and medullary carcinoma (3 cases, 7.5%). Total thryoidectomy was performed in 30 (75%), lobectomy in six (15%), subtotal and multifocal thryoidectomy in two (5%) patients. The median time of follow up was 3 years with range of 1-5 years. After ive years 34 (85%) patients were alive and six (15%) were dead. The overall 5-year actuarial survival was 85%, for papillary carcinoma 91.3%, for follicular carcinoma 85.7% and for medullary carcinoma it was 33.3%. The results suggest that total thryoidectomy had better outcome in comparison with other surgeries.

Impact of gender on cellular immunity following gastrectomy in gastric cancer patients

AIM

To investigate the impact of sex on white blood cells count after gastrectomy in patients with gastric cancer.

METHODS

The study population included 48 patients who underwent total or subtotal gastrectomy for gastric cancer. Total white blood cells, neutrophils and lymphocytes counts of pre and postoperative day 1, 3, and 5 were reviewed from hospital database from 15 March 2009 to 1 December 2011 retrospectively.

RESULTS

This investigation involved 28 male patients (58.33%) and 20 female patients (41.66%). The mean age of male and female patients was 69.4±14.2 and 65.2±15.6 year. There was a significant change in total white blood cells counts in post-operative day 3 (p= 0.041) and post-operative day 5 (p= 0.022) between males and females. Significant change was noted in post-operative day 5 for lymphocytes counts (p= 0.049). Neutrophil values indicated significant alterations in all pre and post gastrectomy days; pre-operative (p= 0.039), post-operative day 1 (p= 0.034), post-operative day 3 (p= 0.012), post-operative day 5 (p= 0.0102).

CONCLUSION

In this comparison between genders, there was a significantly increased proportion of total white blood cells, neutrophils and lymphocytes in female subjects than in male individuals following gastrectomy. Our results revealed that female patients indicated more immune reactions to surgery than male patients. This research provided evidences that gender affects the cellular immunity after surgical stress.

Comparison of oral and intravenous proton pump inhibitor on patients with high risk bleeding peptic ulcers: a prospective, randomized, controlled clinical trial

BACKGROUND

Proton pump inhibitors (PPIs) decrease the rate of rebleeding following endoscopic hemostatic therapy in patients with bleeding peptic ulcers. This study compares the efficacy of oral omeprazole vs intravenous pantoprazole in decrease of rebleeding of peptic ulcer patients.

METHODS

One hundred and six patients with high risk peptic ulcer were randomized to receive either oral omeprazole (80 mg BID for 3 days) or IV pantoprazole (80 mg bolus and 8 mg/hour infusion for 3 days) followed by omeprazole (20 mg each day for 30 days). All patients underwent upper endoscopy and endoscopic therapy within 24 hours.

RESULTS

Seventeen patients were excluded from the study. Forty four patients were randomly allocated into omeprazole group and 41 patients to IV pantoprazole group. Both groups were similar for factors affecting the outcome. Bleeding reoccurred in five patients of omeprazole group and four patients in pantoprazole group (11.4% vs 9.8 %). The mean hospital stay and blood transfusion were not different in both groups.

CONCLUSION

Oral omeprazole and IV pantoprazole had equal effects on prevention of rebleeding after endoscopic therapy in patients with high risk bleeding peptic ulcers.

The Effect of Fig Tree Latex (Ficus carica) on Stomach Cancer Line

BACKGROUND

The therapeutic effect of herbal materials in inhibition of cancer cell growth was shown. This study investigates the effect of fig tree latex (Ficus carica) on stomach cancer line.

METHODS

The in vitro effect of different doses of fig tree latex on stomach cancer cell line and the peripheral blood mononuclear cells was evaluated after 72 hours.

RESULTS

Fig tree latex could inhibit the proliferation of cancer cell line without any cytotoxic effect on human normal cells. Five mg/ml was the optimum concentration in inhibition of cell line growth.

CONCLUSION

Cancer cell line was more sensitive to Ficus carica latex than normal cells. This anticancer activity might be due to presence of its proteolytic enzymes.

Physical and mechanical properties of an experimental dental composite based on a new monomer

OBJECTIVE

The purpose of this study was to investigate the physical and mechanical properties of a dental composite based on BTDMA, a new dimethacrylate monomer based on BTDA (3,3',4,4'-benzophenone tetracarboxylic dianhydride), and to compare these with the properties of a composite based on commonly used Bis-GMA monomer.

METHODS

Experimental composites were prepared by mixing the silane-treated filler with the monomers. The prepared pastes were inserted into the test molds and heat-cured. Light-cured composites were also prepared using camphorquinone and amine as photoinitiator system. Degree of conversion of the light-cured and heat-cured composites was measured using FTIR spectroscopy. The flexural strength, flexural modulus, diametral tensile strength (DTS), water sorption, water contact angle, microhardness and thermal expansion coefficient of the prepared composites were measured and compared. Water uptake of the monomers was also measured.

RESULTS

The results showed that the mechanical properties of the new composite are comparable with the properties of the Bis-GMA-based composite but its water sorption is higher. BTDMA as a monomer containing aromatic rings and carboxylic acid groups in its structure gives a composite with good mechanical properties. There is a close relation between the contact angle, water sorption of the cured composite and water uptake of their monomers.

SIGNIFICANCE

Finding new monomers as alternatives for Bis-GMA have been a challenge in the field of dental materials and any investigation into the properties of new composites would be beneficial in the development of dental materials.

Microencapsulation of allopurinol by solvent evaporation and controlled release investigation of drugs

The microencapsulation of drugs is gaining importance in many research activities. A common technique for preparing microcapsules is the solvent evaporation method which is simple but has a large number of reaction control parameters. This study reports the microcapsulation of allopurinol by the solvent evaporation method and the release of the drug from the microcapsules. The effect of concentration of poly(vinyl alcohol) (as a surfactant), molecular weight of ethyl cellulose and stirrer speed in the preparative method were studied. The effect of molecular weight of ethyl cellulose and particle size on drug release were also investigated. It has been found that the drug release is decreased with increasing molecular weight of polymer and increasing particle size.